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Öğe Adrenal insufficiency caused by bilateral adrenal macrometastases: a rare case with metastatic colon cancer(Kare Publ, 2008) Cicin, Irfan; Uzunoglu, Sernaz; Karagol, Hakan; Usta, Ufuk; Temizoz, Osman; Ermantas, NilayA 42-year-old male with symptoms of weight loss, fatigue, hyponatremia, hypoglycemia, hypotension and fever was referred to our hospital. A computed tomographic scan of the abdomen and pelvis showed multiple solid masses in the liver, thickened wall of sigmoid colon and bilateral solid adrenal masses, 7x5x3 cm on the right side and 6x4.5x3.5 cm on the left side. A colonoscopic examination showed tumoral mass originating from the sigmoid colon. A biopsy was performed and adenocarcinoma was diagnosed. The patient was suspected of having primary adrenal insufficiency due to bilateral adrenal macrometastases. The diagnosis of adrenal insufficiency was confirmed by levels of ACTH serum, cortisol and ACTH stimulation test. Adrenal metastases are well-recognized, but compared with the prevalence of adrenal metastases, adrenocortical insufficiency in patients with cancer seems to be rare. We report the case of a patient with both bilateral surrenal macrometastases, which is rare in colorectal cancer, and subsequent adrenal insufficiency.Öğe ASSESSMENT OF TEN-YEAR-LONG RESULTS OF KIDNEY BIOPSIES PERFORMED ON CHILDREN IN THE THRACE REGION OF TURKEY(Springer, 2015) Ozkayin, Nese; Ciplak, Gokce; Usta, Ufuk; Genchellac, Hakan; Temizoz, Osman[Abstract Not Available]Öğe Bilateral basal ganglionic lesions due to transdermal methanol intoxication(Elsevier Sci Ltd, 2009) Karaduman, Fatih; Asil, Talip; Balci, Kemal; Temizoz, Osman; Unlu, Ercument; Yilmaz, Arif; Utku, UfukMethanol is a clear, colorless, and highly toxic liquid with a similar smell and taste to ethanol, and is found in many commercial products such as solvents and cleaning fluids. Severe methanol intoxication occurs after suicidal or accidental oral ingestion of solvents. A few patients with methanol intoxication via the transdermal route have been reported. We present a 47-year-old woman with acute transdermal methanol intoxication admitted to the emergency department with weakness, blurred vision, bilateral areactive mydriasis, and deterioration of consciousness. (C) 2009 Elsevier Ltd. All rights reserved.Öğe Carotid intima media thickness is independently associated with urinary sodium excretion in patients with chronic kidney disease(Taylor & Francis Ltd, 2015) Ustundag, Sedat; Yilmaz, Gulay; Sevinc, Can; Akpinar, Seval; Temizoz, Osman; Sut, Necdet; Ustundag, AytenAtherosclerosis-induced premature vascular diseases are the leading cause of mortality among patients with chronic kidney disease (CKD). The pathogenetic mechanism of atherosclerosis in patients with CKD has not been fully explained. Experimental studies have demonstrated that high dietary sodium intake not only increases circulatory volume and blood pressure, but also facilitates development of atherosclerosis by reducing production-bioavailability of nitric oxide due to oxidative stress and accordingly by enhancing endothelial and arterial stiffness. In this study, we investigated the relationship between sodium consumption and carotid artery intima-media thickness, which is the indicator of atherosclerosis, by determining daily urinary sodium excretion, which is a reliable indicator of sodium consumption, in our patient group. Our patient group included 193 patients with stage 2-4 non-diabetic CKD and without a history of atherosclerotic disease. We determined that 77% of our patients have been consuming more than 2 g of sodium per day, which is the upper limit of sodium consumption recommended for patients with CKD. We determined a positive linear correlation between carotid artery intima-media thickness and patient age (p < 0.001), C-reactive protein (p < 0.001), urinary sodium excretion (p < 0.001), body mass index (p = 0.002), systolic blood pressure (p = 0.002), hemoglobin (p = 0.030), triglycerides (p = 0.043), and diastolic blood pressure (p = 0.049). We also found a negative linear correlation between carotid artery intima-media thickness and glomerular filtration rate (p = 0.008). We found that urinary sodium excretion is the determinant of intima-media thickness even if all factors associated with intima-media thickness are adjusted, and that intima-media thickness increases by 0.031 (0.004-0.059) mm per 2 g increase in daily sodium excretion, independent from overall factors (p = 0.025). Our results reveal a relation between urinary sodium excretion and carotid artery intima-media thickness and suggest that excessive sodium consumption predisposes development of atherosclerosis in patients with CKD.Öğe Computed Tomographic and Magnetic Resonance Imaging Findings of Asymptomatic Intra-Abdominal Gastrointestinal System Lipomas(Lippincott Williams & Wilkins, 2008) Genchellac, Hakan; Demir, Mustafa K.; Ozdemir, Huseyin; Unlu, Ercument; Temizoz, OsmanLipomas are common benign mesenchymal neoplasms documented in literature. This study aimed to describe the computed tomographic (CT) and magnetic resonance imaging (MRI) findings of gastrointestinal system lipomas, all of which are incidentally found in routine abdominal imaging studies. Lipomas were depicted as homogeneous, nonenhancing, well-marginated lesions consistent with adipose tissue on CT and MRI The density measurements on CT images consistent with fat are virtually diagnostic. Lipomas can incidentally be found and should be considered in the differential diagnosis of soft tissue gastrointestinal system-related masses. Computed tomographic or MRI examinations can correctly diagnose a lipoma nonoperatively, thereby allowing better treatment planning..Öğe Contrast-enhanced MR 3D angiography in the assessment of brain AVMs(Elsevier Ireland Ltd, 2006) Unlu, Ercument; Temizoz, Osman; Albayram, Sait; Genchellac, Hakan; Hamamcioglu, M. Kemal; Kurt, Imran; Demir, M. KemalBackground and purpose: Digital subtraction angiography (DSA) is the current reference standard for the diagnosis, assessment, and management of brain arteriovenous malformations (AVMs). The purpose of this study was to compare the diagnostic utility of three-dimensional (3D) time-off-light (TOF) magnetic resonance angiography (MRA) and contrast-enhanced 3D MRA in patients with intracranial arteriovenous malformations (AVMs) in different sizes and locations. The AVM diagnosis was proved via DSA and almost half of the patients had also hematoma. Materials and methods: Two radiologists, experienced on neurovascular imaging and independent from each other, retrospectively reviewed two MRA techniques and DSA with regard to the assessment of feeding arteries, AVM nidus, and venous drainage patterns on 20 patients with 23 examinations by scoring system. Disagreements were resolved by consensus. Results: An excellent agreement between contrast-enhanced MRA and DSA was found in order to assess the numbers of arterial feeders and draining veins (Spearman r=0.913, P<0.001). The average scores in contrast-enhanced MRA for feeders, nidi, and drainers were respectively 2.26, 2.69, and 2.48, while in TOF-MRA they are 1.96, 1.35, and 0.89, respectively. Conclusion: Compared to TOF-MRA, 3D contrast-enhanced MRA is useful for visualization by subtraction technique of malformation components presented by hematoma or by haem product. On the other hand, for the cases presented by slow or complex flow that is especially in around or nidi or around the venous portion is also advantageous because of the independence from flow-related enhancement. Therapeutic effects were clearly demonstrated in three follow-up patients. A major limitation of this technique is the low spatial resolution. Since there is such a limitation, arterial feeder of a case with micro-AVM is not detected by contrast-enhanced MRA and nidus for the same case was observed retrospectively. In this respect, we believe that 3D contrast-enhanced MRA is a less invasive and inexpensive angiographic tool, but not a safe substitute for DSA. Yet, it can be a beneficial supplement to DSA in patients with cerebral AVMs at both initial diagnosis and at follow-up processes after therapy. (C) 2006 Elsevier Ireland Ltd. All rights reserved.Öğe A cost analysis of radiologic imaging in pediatric trauma patients(Turkish Assoc Trauma Emergency Surgery, 2010) Guzel, Ahmet; Temizoz, Osman; Aksu, Burhan; Sut, Necdet; Karasalihoglu, SerapBACKGROUND The aim of this study was to examine the cost of radiologic imaging in pediatric trauma patients admitted to the pediatric emergency department. METHODS All patients were retrospectively evaluated according to age, gender, details of injury, radiological investigations ordered and their results, cost of radiologic imaging, length of stay, outcome of the injury, and hospitalization rates. RESULTS The cost of radiologic imaging was retrospectively analyzed in 1231 trauma patients aged between one month and 15 years (mean 5.91 +/- 3.82 years). For the 996 patients who had radiological imaging, 3382 images were taken in total. Of these, only 300 (8.8%) were abnormal. The mean (and SD) total cost of radiologic imaging was US$ 40.42 ($34.38) (range $4.67 to $139.26). Total cost correlated inversely with Glasgow Coma Scale (GCS) (r=-0.37, p<0.001), directly with Injury Severity Score (ISS) (r=0.27, p<0.001) and was not correlated with the Pediatric Trauma Score (PTS) (r=-0.16, p>0.05). The mean (and SD) duration of hospital stays was 8.54 (10.91) hours. CONCLUSION Advanced radiological images may help in early diagnosis of trauma cases. However, periodic education programs to prevent unnecessary radiological imaging in emergency departments are also necessary to decrease the cost of these imaging modalities.Öğe Cranial mr venography findings of severe hypernatremic dehydration in association with cerebral venous thrombosis in the neonatal period(Taylor & Francis Inc, 2007) Duran, Ridvan; Aladag, Nukhet; Vatansever, Uelfet; Temizoz, Osman; Genchallac, Hakan; Acunas, BetulSevere neonatal hypernatremia is an important electrolyte disorder that has serious effects on the central nervous system, including brain edema, intracranial hemorrhage, hemorrhagic infarct, and thrombosis. Cerebral venous thrombosis is relatively rare in severe neonatal hypernatremic dehydration. The English literature contains only a few reports of the cranial radiological findings in severe neonatal hypernatremia. The authors report cranial MR venography findings of a newborn infant with severe hypernatremic dehydration. To the best of their knowledge, this is the first such report in the English literature.Öğe CT-angiographic demonstration of hepatic collateral pathways due to superior vena cava obstruction in Behcet disease(Turkish Soc Radiology, 2010) Temizoz, Osman; Genchellac, Hakan; Yekeler, Ensar; Demir, Mustafa Kemal; Unlu, Ercument; Ozdemir, HuseyinBehcet disease (BD) is a chronic multisystemic inflammatory disorder, mainly characterized by recurrent oral and genital ulcers, skin lesions, and uveitis. Large vein thrombosis in BD is unusual; when present, it is most frequently seen in the inferior or superior vena cava (SVC). The authors describe an unusual hepatic pseudolesion caused by abnormal focal enhancement through collateral pathways to the liver in two BD patients with SVC occlusion on three-dimensional multi-detector computed tomography, using volume rendering and maximum intensity projection techniques. BD should be suspected in patients presenting a focal increased hepatic enhancement area with collaterals caused by occlusion of the SVC without evidence of a hypercoagulable state or malignant mediastinal or thoracic venous inlet obstruction.Öğe A Destroyer Immunologic Cause in Small Cell Lung Carcinoma: Ectopic Cushing's Syndrome(Ekin Tibbi Yayincilik Ltd Sti-Ekin Medical Publ, 2010) Cicin, Irfan; Uzunoglu, Sernaz; Ermantas, Nilay; Usta, Ufuk; Temizoz, Osman; Karagol, HakanEctopic secretion of adrenocorticotropic hormone (ACTH) related Cushing's syndrome (CS) is more frequently observed than many other paraneoplastic syndromes in patients with small cell lung cancer. Suppression of the cellular immune system in these patients is severe problem for both patients and physicians. In addition, the chemotherapy has been caused to severity and higher rate of hematological toxicity. We present a case of small cell lung cancer having a very poor prognosis, with a compressed humoral and cellular immune system due to an ectopic secretion of ACTH related CS. We report a rare case of combined immunosuppression in a case with small cell lung cancer in this paper. In addition, in the light of this special case and literature, we suggest treatment strategies for small cell lung cancer patients with CS.Öğe Detection and quantification of the parenchymal abnormalities in emphysema using pulmo-CT(Pergamon-Elsevier Science Ltd, 2007) Temizoz, Osman; Etlik, Omer; Sakarya, Mehmet Emin; Uzun, Kursat; Arslan, Halil; Harman, Mustafa; Demir, Mustafa KemalWe aimed to determine the degree and extent of parenchymal abnormalities on pulmo-CT in patients with emphysema. The study group consisted of 29 patients (18 male, I I female; mean age 57.9. L 13). The diagnosis was based on clinical symptoms, pulmonary function tests (PFT) values, and chest CT findings. All of the patients CT scans were obtained during suspended deep inspiration from the apices to the costophrenic angles. The mean lung attenuation (MLD) and parenchymal abnormalities related to emphysema were quantitatively calculated with tables, histograms and graphics at the whole lung. The lung density measurements revealed a mean density of -898.48 +/- 51.37 HU in patients with emphysema and -825.1 +/- 25.5 HU in control group. In addition, mean percentage of subthreshold attenuation values was found as 12.03 +/- 15.75 and 1.07 +/- 0.83 in patients with emphysema and control group, respectively. Compared with control group, the patients with emphysema had a significantly lower inspiratory MLD (p < 0.05). Additionally, statistically significant correlations were seen between the MLD and percentage of subthreshold values (r = 0.44, p < 0.05). In contrast, there was poor correlation between PFT measurements and the subthreshold values. In conclusion, pulmo-CT is a quick, simple method for quantitative confirmation of the presence of parenchymal abnormalities of lung as mosaic attenuation and should be used in combination with other radiological methods and PFT as it gives additional information to routine examinations in patients with emphysema. (c) 2007 Elsevier Ltd. All rights reserved.Öğe Digital subtraction angiography of a persistent trigeminal artery variant(Aves, 2010) Temizoz, Osman; Genchellac, Hakan; Unlu, Ercuement; Cagli, Bekir; Ozdemir, Hueseyin; Demir, M. KemalPersistent trigeminal artery variants are described as cerebellar arteries that directly originate from the precavernous segment of the internal carotid artery. This has been observed in 0.18% of cerebral catheter angiograms. On the other hand, a persistent trigeminal artery variant feeding both the anterior inferior cerebellar artery and the posterior inferior cerebellar artery territory is very rare. We present this uncommon anomalous artery along with digital subtraction angiography findings and discuss its clinical significance in light of the literature.Öğe Erdheim-Chester Disease Presented with Bilateral Carotid Artery Occlusion: Case Report(Turkish Neurological Soc, 2010) Celik, Yahya; Balci, Kemal; Asil, Talip; Tuzun, Erdem; Hamamcioglu, Mustafa Kemal; Temizoz, Osman; Albayram, SaitErdheim-Chester disease is a rare, non-Langerhans form of systemic histiocytosis of unknown etiology. The disease affects multiple organ systems, including musculoskeletal, cardiac, pulmonary, gastrointestinal, and central nervous systems, producing protean manifestations. Neurological manifestations are less frequent. We present a 44-year-old patient with Erdheim-Chester disease who had bilateral carotid artery occlusion and cavernous sinus infiltration.Öğe Evaluation of Pancreatic Malign Tumours with Mangafodipir Trisodium(Aves Yayincilik, Ibrahim Kara, 2009) Argimak, Yasin; Temizoz, Osman; Tosun, Alptekin; Cakir, BilgeObjectives: Our study aimed to assess the diagnostic capabilities of mangafodipir trisodium (Mn-DPDP)-enhanced magnetic resonance imaging for the evaluation of pancreatic malign mass. Patients and Methods: Magnetic resonance images of 17 patients (7 females, 10 males; mean age 63.2 +/- 12 years; range 36 to 80 years) suspected of pancreatic tumor by abdominal ultrasonography and computed tomography findings, were examined in terms of signal to noise (S/N) and contrast to noise (C/N) ratios before and after administration of Mn-DPDP using T1 A SE, Fat Sat T1 A SE and GRE T1 A sequences. Results: Before and after administration of Mn-DPDP, the increase in S/N ratios of normal pancreatic parenchyma were found as 22.81%, 32.88% and 20% in T1 A SE, Fat Sat T1 A SE and GRE T1 A sequences, respectively. The increase in C/N ratios obtained from signal intensity values of normal pancreatic tissue and tumor were found as 58.69%,125.41% and 62.06% in T1 A SE, Fat Sat T1 A SE and GRE T1 A sequences, respectively. Furthermore, in all sequences, before and after contrast medium administration, the increase of C/N ratios were found statistically significant (paired Student's t test, P<0.0001). Conclusion: The differences of C/N ratio using Mn-DPDP as a contrast agent may contribute to the diagnosis of pancreatic malign masses.Öğe Fibroblast Growth Factor-23 and Carotid Artery Intima Media Thickness in Chronic Kidney Disease(Clin Lab Publ, 2015) Yilmaz, Gulay; Ustundag, Sedat; Temizoz, Osman; Sut, Necdet; Demir, Muzaffer; Ermis, Veli; Sevinc, CanBackground: The cause of early-accelerated atherosclerosis development observed in Chronic Kidney Disease (CKD) is not fully understood. The determination of the relationship between the levels of fibroblast growth factor 23 (FGF-23) and the development of endothelial dysfunction, left ventricular hypertrophy, and myocardial infarction lends support to the possibility that FGF-23 plays a role in the development of atherosclerosis in CKD. Only a few studies, however, have been conducted that analyze the relationship between FGF-23 levels in the progression of CKD and the development of atherosclerosis, and these studies have generally been limited to those patients receiving dialysis therapy due to end stage renal disease (ESRD). Methods: In the present study, carotid artery intima-media thicknesses (IMT) were measured ultrasonically as a marker of atherosclerosis in 91 patients with CKD stage 3 - 4 (61 female and 30 male, age between 19 - 65 years, glomerular filtration rate [GFR] 15 - 60 mL/min 1.73 m(2), CKD was not related to diabetes mellitus, and without cardiovascular-cerebral disease) in contrast to 36 healthy volunteers (26 female and 10 male, age between 19 - 65 years, GFR > 90 mL/min 1.73 m(2), and without any diagnoses of acute or chronic disease), and a possible role of FGF-23 on atherosclerosis was analyzed. Results: Patients were similar to controls with respect to age, gender, smoking status, body mass index, and plasma glucose and lipid profile. On the other hand, IMT measurements (p < 0.00001) and FGF-23 levels (p = 0.00012) were significantly higher in patients than controls. IMT was measured above the subclinical atherosclerosis limit of 0.750 mm in 54% of the patients. Multivariate regression analysis showed that patients' age, high sensitive c-reactive protein (hsCRP), and FGF-23 levels were independent predictors of IMT (p < 0.00001, r = 0.559). Independent of other variables, every 1 mu mol/L increase in FGF-23 levels resulted in 0.444 mm increase of IMT measurements in patients with CKD. Conclusions: Our findings suggest that monitoring serum FGF-23 may be useful as a non-invasive indicator of subclinical atherosclerosis in patients with chronic kidney disease.Öğe Fournier's gangrene(Springer-Verlag Italia Srl, 2009) Kavalci, Cemil; Cevik, Yunsur; Durukan, Polat; Temizoz, Osman[Abstract Not Available]Öğe Hypothenar hammer syndrome(John Wiley & Sons Inc, 2008) Genchellac, Hakan; Demir, Mustafa Kemal; Unlu, Ercuement; Temizoz, Osman; Ozdemir, HuseyinWe report a case of hypothenar hammer syndrome following a single severe blunt trauma in a 24-year-old man with a painful pulsatile mass, numbness in the fourth and fifth fingers, and intolerance to cold. The gray-scale and color Doppler sonographic findings are presented with correlation with MRI. (C) 2007 Wiley Periodicals, Inc.Öğe Incidental Pancreatic Lipomas: Computed Tomography Imaging Findings with Emphasis on Diagnostic Challenges(Elsevier Science Bv, 2010) Temizoz, Osman; Genchellac, Hakan; Unlu, Ercument; Kantarci, Fatih; Umit, Hasan; Demir, Mustafa KemalPurpose: The purpose of this study was to describe the computed tomography (CT) findings of pancreatic lipomas of 9 cases, with emphasis to diagnostic challenges. Methods: Between March 2006 and April 2008, 9 patients with pancreatic lipomas that were diagnosed by CT were reviewed in the present study. Clinical data and CT features of these 9 cases were retrospectively analysed. The patient population included 5 men and 4 women, aged 42-81 years (mean age, 65.8 years). The patients were followed up for at least 2 years with control CTs. Results: In all 9 cases, a well-bordered nodular fat density lesion was incidentally detected in the pancreas. Four of the lesions had a lobulated contour, and 2 of them had septations. Two of the lipomas were located in the head, 3 in the neck, 3 in the corpus, and 1 in the tail. The CT densitometric values were between -90 and -120 HU, with a mean value of 106 HU. No pancreatic or biliary dilatation or compression to the adjacent structures was seen. All the cases had control CTs, and the lipomas remained unchanged during the follow-up period. Histopathologic confirmation of the diagnosis was not planned for the cases. Conclusion: Lipomas are rarely encountered in the pancreas. They often are diagnosed coincidentally as small, well-circumscribed, encapsulated, homogeneous, mature adipose masses on imaging studies. Imaging follow-up strategy or histopathologic confirmation is not necessary in asymptomatic patients.Öğe Indications for Brain Computed Tomography and Hospital Admission in Pediatric Patients with Minor Head Injury: How Much Can We Rely upon Clinical Findings?(Karger, 2009) Guzel, Ahmet; Hicdonmez, Tufan; Temizoz, Osman; Aksu, Burhan; Aylanc, Hakan; Karasalihoglu, SerapObjectives: The aim of this study was to describe the characteristics of patients with a minor head injury (MHI) who were admitted to a pediatric emergency unit and to identify the clinical signs and symptoms that most reliably predict the need for cranial computed tomography (CCT) and hospital admission following MHI. Methods: All patients were retrospectively evaluated according to age, gender, details of injury, presenting symptoms, physical examination findings, radiological investigations ordered and results, length of stay, outcome of the injury and hospitalization rates. Results: The factors affecting indications for computed tomography and hospitalization were retrospectively analyzed in 916 patients - 585 males and 331 females, aged between 1 month and 15 years (mean: 5.01 +/- 3.58 years), with MHI. A multivariate analysis revealed significant correlations between CCT abnormalities and Glasgow Coma Scale scores of 13 or 14, headache, posttraumatic amnesia, blurred vision, cephalohematomas, periorbital ecchymoses, otorrhea and abnormal neurological findings. CCT abnormalities were identified in 67 (19.8%) of the 338 CCT scans. Twenty of the 67 patients (29.9%) with CCT scan abnormality had no clinical signs. Of all cases, 125 (13.6%) were hospitalized, 617 (67.4%) were treated as outpatients, and 174 (19.0%) left the emergency department based on a personal decision. Conclusion: Some clinical risk factors can be used as predictors of abnormalities in CCT scans following MHI, but the absence of such clinical findings does not exclude the possibility of intracranial injuries. Copyright (C) 2009 S. Karger AG, BaselÖğe Inflammatory myofibroblastic tumor presenting as an abdominal wall mass in an adult patient(Wolters Kluwer Medknow Publications, 2010) Yagci, Mehmet Ali; Sezer, Atakan; Yeldan, Eyup; Coskun, Irfan; Usta, Ufuk; Cicin, Irfan; Temizoz, OsmanInflammatory myofibroblastic tumor of the abdominal wall is a rare soft-tissue tumor presentation in adults. A 50-year-old woman was referred with abdominal pain and a palpable mass in the left lower quadrant. Computed tomography scan and magnetic resonance investigation revealed an 8-cm heterogeneous abdominal wall mass. Tumor markers were within normal limits. Fine-needle aspiration cytology and tru-cut biopsies yielded necrotic material. A preoperative diagnosis of a resectable rhabdomyosarcoma was suggested. On exploration a tumor measuring 8 x 8 x 6 cm was resected along with the involved structures. Histopathologic examination of specimen revealed an inflammatory myofibroblastic tumor of the abdominal wall. The patient has been followed up for the last 12 months without clinical or radiographic evidence of recurrence. Inflammatory myofibroblastic tumor arising from the anterior abdominal wall in adults is an unusual manifestation of soft-tissue tumors, which can be managed by a multidisciplinary team of surgeons, oncologists, radiologists and pathologists.
